Provider Demographics
NPI:1568961290
Name:JOHNSON, MALINDA M (LPC)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ARROWHEAD ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-6307
Mailing Address - Country:US
Mailing Address - Phone:203-558-2557
Mailing Address - Fax:
Practice Address - Street 1:9 ARROWHEAD ROAD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-6307
Practice Address - Country:US
Practice Address - Phone:203-558-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional